INTEGRATING CLINICBASED AND COMMUNITYBASED INTERVENTIONS TO PROMOTE THE WELLBEING OF ATRISK YOUTH

1
INTEGRATING CLINIC-BASED AND COMMUNITY-BASED
INTERVENTIONS TO PROMOTE THE WELL-BEING OF
AT-RISK YOUTH

• Sarah Caliboso-Soto, LCSW
• Karen Adams, LCSW
• Officer Anthony Campbell
• Deputy Gregory James

2
MISSION STATEMENT

• The Mission of Kedren Community Health Center,
  Inc. (dba, Kedren Head Start and Kedren Acute
  Psychiatric Hospital and Community Mental Health
  Center (Kedren) is to provide culturally
  competent continuum of care services utilizing an
  efficient and effective collaborative and
  holistic approach to address the health and
  mental health needs of residents in Service Area
  6.

3
BACKGROUND

• 1965 Kedren was founded by James L. Jones,
  M.D., a child psychiatrist in response to a needs
  assessment conducted in Watts/Willowbrook
  following the Watts Riots.
• Identified Problems Impoverished educational,
  occupational, social, environmental and economic
  circumstances prevalent in the community.

4
LOS ANGELES COUNTY SERVICE PLANNING AREAS
5
Service Area 6COMMUNITY ETHNIC COMPOSITION
Total Population - 985,054
Los Angeles Childrens Planning Council
6
Service Area 6COMMUNITY COMPOSITION

• 32 Live Below Poverty Level
• Average Median Household Income
• 23,982
• 33.78- less than 15,000
• 33.57- 15,000 to 34,999
• 25.25- 35,000 to 74,999
• 7.39- 75,000 and more

Los Angeles County Department of Mental Health
7
Service Area 6COMMUNITY CHARACTERISTICS

• 53 of adults achieved less than a high school
  diploma1
• Unemployment rate is 151
• 11,670 persons are homeless, many with severe
  mental illness substance abuse2
• 19,932 children is the area have open cases with
  DCFS3

1State of California, Employment Development
Department 2Los Angeles Homeless Service
Authority 3Los Angeles County, Department of
Mental Health
8
Service Area 6COMMUNITY CHARACTERISTICS (contd)

• Population Density
• Overcrowded Housing Conditions
• Substance Abuse
• Residents Involved in the Criminal Justice System
• Gang Activity

9
KEDREN HEAD START/STATE PRE-SCHOOL2007-2008

• 28 Sites
• Service 2,318 Children and their families
• 95 of families are at or below Federal poverty
  level
• Over 10 of enrolled children have special needs
  autism,
• speech language and other developmental
  delays

10
KEDREN MENTAL HEALTH CENTER TREATMENT
POPULATION BY ETHNIC STATUS AND AGE
11
KEDREN PROVIDES THE FOLLOWING SERVICES

• Outreach Information and Referral
• Assessment and Crisis Intervention
• Mental Health Services
• Medication Support
• Case Management
• Transitional Youth Services
• Acute In-Patient Psychiatric Care

12
PROGRAMS FOR CHILDREN AND YOUTH

• Outpatient Program
• School Based Mental Health Program
• Intensive Outpatient Program
• Day Treatment Program
• Childrens Acute Psychiatric Hospital

13
THE MEDICAL MODELAN EARLY MODEL FOR SOCIAL WORK
PRACTICE

• STUDY
• DIAGNOSIS
• TREATMENT
• CURE

• Assessment
• DSM IV
• Therapy
• Cure?

• Focus on the individual with the problem
• Assumes the professional has the knowledge
• and power to cure

14
NEW PROGRAMS

• Mental Health Service Act (MHSA)
• The Mental Health Service Act Represents a bold
  new approach to management of the mentally ill.
  The Recovery Model represents a paradigm shift
  from a focus of the Disease Model of Illness -
  what is wrong with the person to Wellness what
  would it look like if this person was functioning
  well?

15
FULL SERVICE PARTNERSHIP
16
FSP SERVICES PROVIDED

• Individual and Family Therapy
• Small Caseloadfrequent contact
• Community based meet the client in
  home/school/community meet the client in their
  own environment
• Flexible Funding for housing, clothing, food
  meeting basic need obtaining other fee for
  service linkages ex. anger management, substance
  abuse counseling, tutoring etc
• Medication Evaluation and Monitoring
• Transportation
• Intensive Targeted Case Management
• Relies heavily on CM to link and wrap the client
  with services to promote higher functioning

17
FULL SERVICE PARTNERSHIP (FSP)

• Designed to deliver 24/7 in-home and/or community
  based treatment to targeted patients classified
  as high utilizers of mental health services
• At Kedren
• Adults (26 years and older) N80
• Transitional Age Youth (16-25) N28
• Children (Birth to 15) N53

18
FSP ADULT CRITERIA

• Axis I Diagnosis
• Homeless
• In jail or has frequent contact with the criminal
  justice system
• Frequently in psychiatric hospitals or receiving
  psychiatric emergency services
• In an Institution for Mental Disease (IMD) or
  State Hospital
• Living with family members and at risk of the
  above

19
FSP/TAY - CRITERIA

• Axis I Diagnosis
• Homelessness or at risk of homelessness
• Aging out of DMH/DCFS/Probation
• Leaving Long-term Institutional care
• Experiencing first psychotic break
• Co-Occurring Substance Abuse Disorder

20
FSP/CHILD (0-15 yrs) CRITERIA

• Axis I Diagnosis
• 0-5years
• - at risk of removal from home by DCFS
• - at risk for expulsion from preschool
• - parent with persistent mental illness or
  substance abuse
• 6-15years
• - at risk of removal from home by DCFS
• - is in transition to less restrictive
  environment
• - violent behaviors/at risk or suspension or
  expulsion/ use or possession of substance/
  suicidal/homicidal ideation

21
PREVIOUS LINKAGE AND COLLABORATIVE EFFORTS

• ID Resource
• Linked to Resources
• Follow- up problems to linkage
• Continued consultation was limited once linkage
  was made due to high caseloads

22
COLLABORATIONS

• State and County
• Los Angeles County of Department of Mental Health
• Los Angeles County Department of Children and
  Family Services
• Probation
• Office of State Health Planning and Development
• Social Securities Administration
• LAPD
• South Central Regional Center for Developmental
  Disabilities
• Educational
• LA Unified School District
• Compton School District
• Los Angeles Trade Tech College

• University of Southern California
• CSU Long Beach
• Los Angeles City College
• Fuller Theological Seminary
• Chapman University
• Fremont Adult School
• Mental Health
• Coalition of Mental Health
• Professionals
• Didi Hirsch Mental Health
• Center
• LA Child Guidance Center
• NAMI Urban Los Angeles
• Faith Based
• Clergy Councils of Los Angeles

23
BARRIERS TO LINKAGES

• Funding Family has limited income
• Transportation
• Inappropriate Referral

24
CURRENT FSP COLLABORATIONS

• Project Impact
• Boys and Girls Club of America
• UPAC United Peace Officers Against Crime

25
FAMILIES IMPACTED ON A DAILY BASIS

• Chronic Exposure to Community Violence
• Helicopter overhead
• Sound of gunshots
• Family and friends in gangs
• Drive-by shootings
• Intimidating presence in neighborhood

26
CRIMES WITHIN SERVICE AREA 6

• 21.7 Domestic Violence
• Calls
• 9.3 Adult Arrests
• 11.8 Juvenile Arrests

United Way of Greater Los Angeles
27
GANG VIOLENCE

• Over 1,300 Active Gangs in Los Angeles County1
• Estimated Membership of 46,000 Teens and Adults1
• YTD 2008 3,941 Gang Related Crimes in the City
  of Los Angeles2

1United Way of Los Angeles 2LAPD
28
STRATEGIES TO ADDRESS YOUTH GANGS

• Gang Suppression Programs
• Specialized gang units (typically led by police
  and/or criminal prosecutors) that target gang
  members their illicit activities through
  aggressive enforcement of laws.

29
STRATEGIES TO ADDRESS YOUTH GANGS (contd)

• 2. Gang Intervention Programs
• Generally target active gangs and gang members.
• Services provided in gang members own
  environment.

30
STRATEGIES TO ADDRESS YOUTH GANGS (contd)

• 3. Gang Prevention Programs
• Typically focus on discouraging children
• and youth, especially those at high-risk,
• from joining gangs.

31
KEDREN/UPAC PARTICIPANTS

• 16 Total Participants
• Age Range
• 10-15 Years
• Gender
• 75 - Male
• 25 - Female
• Ethnicity
• 25 - Latino
• 75 - African American

32
KEDREN/UPAC PARTICIPANTS (contd)

• DIAGNOSIS
• ADHD
• ODD
• Disrupted Behavior Disorder
• Bipolar Disorder NOS
• PTSD
• Mood Disorder

33
KEDREN/UPAC

• Criteria
• High risk of suspension/expulsion from school
• At risk of removal from home by DCFS
• Involved with Probation
• Engaging or at risk of engaging in substance
  abuse/violent behaviors or other high risk
  behaviors

34
GOALS AND OBJECTIVES

• Promote personal and social responsibility
• Develop individual potential
• Develop appreciation for self and others
• Develop academic proficiency
• Provide a network of support and guidance to
• at-risk youth
• Reduce juvenile delinquency and gang
  participation
• Discourage the use of illegal drugs and firearms
  and involvement in violence and other delinquent
  activity
• Encourage participation in community service
  activities

35
PROGRAM FOSTERS

• Positive self image and self esteem
• Strengthens family relationships
• Leadership skills

36
UPACUNITED PEACE OFFICERS AGAINST CRIME
37
CHALLENGES/LESSONS LEARNED ALONG THE WAY

• On-going Communication
• Open Minded
• Flexible
• Parent Involvement Challenge

38
WHAT THE FUTURE HOLDS.

• Evidence Based
• Collecting Data
• Outcome Measures
• Research Opportunities

39
FOR MORE INFORMATION

• Email
• k_adams_at_kedrenmentalhealth.org
• s_caliboso_at_kedrenmentalhealth.org
• gregory.james_at_laprobation.org
• upacc_at_aol.com